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Web-based counseling -- Telepsychiatry -- is taking off

Lucas Mearian | Feb. 10, 2012
Telemedicine has been around since the 1990s, but psychiatrists say it's increasingly used to treat remote patients as technology and security improves, and prices drop.

Chandran's web conferencing system has full high-definition capabilities -- 1080P resolution running at 30 frames per second -- which allows Chandran to see even subtle ticks or other visual signs that may reveal problems.

The software ensures that the video stream is encrypted using the 128-bit AES algorithm and digital certificates.

"The average laptop is not what it used to be. If our customers bought a $600 laptop and connected a Logitech webcam to it, they'd be trilled," said Eric Kintz, general manager of Logitech for Business.

"It is as good as a face-to-face consultation, but you're doing it on your $80 a month Internet connection, a $600 computer and a $90 webcam," said Jim Mountain, president of Secure TeleHealth. "This is one of most promising areas available to cut Medicaid costs. The avail of a psychiatrist to a patient can help avoid hospitalization. Once you're admitted [to a hospital], costs climb into the $50,000 to $100,000 range."

As government grants for network and electronic healthcare systems -- particularly for rural areas -- grow, telemedicine will continue to expand across the nation, said Fishkind, CEO and chief medical officer for JSA Health Telepsychiatry, a health care firm that with 24 part-time or full-time psychiatrists who treat emergency patients in Texas and Louisiana.

The company provides on-demand telepsychiatrists for patients in schools, jails, community health centers, and hospital emergency departments.

Telepsychiatry's roots

Telemedicine and telepyschiatry began in the 1990s with the maturation of the World Wide Web and the ability to communicate online with patients using email and instant messaging.

The fledgling industry targeted people living in rural areas, and were unable to make the trek to clinics and private practices. Early on, video conferencing was difficult due to the lack of Internet bandwidth.

In 1999, a group emergency psychiatrists, including Fishkind, who specialized in crisis situations met to discuss the potential of telepsychiatry. The group concluded that most psychiatric crises occur in jails, shelters, schools, homes and hospital ICU units.

"Most of us were practicing in tertiary care -- medical school-based hospitals where the emergency room had a separate psychiatric care unit," Fishkind said. "When you looked at the numbers, this is where probably 1% of all psychiatric emergencies took place.

"It became obvious even then that eventually, the only way to bring emergency psychiatry where it was needed would be through telemedicine," he said.

But early on, high-definition video conferencing technology cost tens of thousands of dollars. Additionally, security was an even greater concern than today.

Most doctors or healthcare regulators wouldn't embrace having psychiatric sessions over the public Internet. One more secure option, virtual private networks, required strong technical expertise and significant network bandwidth.


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